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Critical Limits of Laboratory Results For Urgent Clinician Notification
Critical Limits of Laboratory Results For Urgent Clinician Notification
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Table 1: Adult and paediatric limits of laboratory results which, after confirmation
through repeat measurement in the same sample, need urgent notification of the
physician
Ammonia > 100 mg/dl (59 Risk of hepatic encephalopathy. Comatose states
mmol/l) do not usually occur unless levels exceed 300
mg/dl (176 mmol/l).
Ethanol > 3.5 g/l (76 Blood alcohol concentrations of 3-4 g/l can be
mmol/l) fatal, even in those who are not simultaneously
using medicinal products.
> 3.5 %
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Parameter Value Note
Creatinine > 7.4 mg/dl (654 Acute renal failure, e.g. in multiple organ failure
mmol/l) or sepsis.
Creatine kinase > 1000 U/l Notification depends on the patient population of
the clinic or practice in question.
Digoxin > 2.0 mg/l (2.56 Non-cardiac symptoms such as tiredness, muscle
nmol/l) weakness, nausea, vomiting, lethargy, and
Digitoxin headache and cardiac symptoms such as sinus
> 40 mg/l (52 arrhythmia, bradycardia, and various degrees of
nmol/l) AV block.
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Parameter Value Note
Leukocyte < 2000/ml High risk of infection if the granulocyte count is <
count 500/ml.
> 50,000/ml
Indicative of leukemoid reaction, e.g. in sepsis, or
of leukemia.
Magnesium < 1.0 mg/dl (0.41 Characteristic symptoms are paresthesias, cramp,
mmol/l) irritability, and athetoid tetany. The patient often
shows cardiac arrhythmia in conjunction with
> 4.9 mg/dl (5.0 hypokalemia; arrhythmia is intensified by
mmol/l) digitalis.
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Parameter Value Note
Osmolality < 240 mOsm/kg Cellular oedema with an increase in cell volume
H2O and development of neurological-psychiatric
symptoms.
> 330 mOsm/kg
H2O Cellular water loss and intracellular increase in
osmotically active substances, which do not
permeate the cell membrane. Result: central
symptoms and coma.
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Parameter Value Note
Thromboplastin > 27 sec (approx. Decrease in the vitamin K-dependent factors II,
time (TT) 50%) VII, and X or in factor V. Since all these factors
are synthesized in the liver, a decrease in the TT
to values below the specified level indicates a
considerable disturbance of synthesis. In persons
receiving coumarin therapy, there is a risk of
haemorrhage if the TT is < 15% – which
corresponds roughly to an INR of > 4.
Uric acid > 13 mg/dl (773 Acute urate nephropathy with tubular blockade
mmol/l) and renal failure. The uric acid/creatinine ratio in
spontaneous urine in such cases is > 1.0 (mg/mg).
Urea > 214 mg/dl (35.6 Indicative of acute renal failure; unlike pre-renal
mmol/l) and post-renal kidney failure, no
BUN disproportionate increase in urea compared to
> 100 mg/dl (35.6 creatinine in serum.
mmol/l)
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Table 2: Critical limits of qualitative laboratory results which must be reported to
the treating physician immediately
Cerebrospinal fluid
• Suspected leukemia
• Suspected aplastic crisis
• Sickle cells
• Malarial parasites
Microbiology · Detection of pathogens in Gram staining of blood culture or of exudates and
transudates of body cavities
• Antigenic detection of pathogens with rapid tests such as latex agglutination, immunofluorescence, or immunoassay, e.g. group B
streptococci, legionella, Pneumocystis carinii, Cryptococcus, hepatitis B
• Detection of acid-fast bacilli or detection of M. tuberculosis after amplification (PCR)
• Cultural detection of salmonellae, shigella, Campylobacter, C. difficile, C. perfringens, N. gonorrhoeae, B. pertussis, N.
menin-gitidis, C. diphtheriae, and pathogenic fungi such as Aspergillus, Blastomyces, Coccidioides, Histoplasma, and Cryptococcus
• Detection of HIV antibodies
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Table 3: Neonatal quantitative limits of laboratory results which, after confirmation
through repeat measurement in the same sample, need urgent notification by the
physician.
Bilirubin > 14 mg/dl (239 On first day of life, e.g. in hemolytic disease of the
mmol/l) newborn; risk of kernicterus.
Hemoglobin < 8.5 g/dl Risk of multiorgan failure, especially if the patient
has a combination of ischemia and hypoxia.
Igm > 20 mg/dl A cord blood IgM concentration above the limit can
be linked to an intrauterine infection.
Leukocyte count < 5,000/ml Values below and above these limits can be
indicative of neonatal sepsis.
> 25,000/ml
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